Adhesive Capsulitis (Frozen Shoulder)
Adhesive capsulitis, or frozen shoulder, is a painful condition which results in a severe loss of motion in the shoulder. It may follow an injury to the shoulder, but may also arise gradually with no warning or injury.
The cause of this condition is still unknown. One theory is that the condition may be due to an autoimmune reaction. During an autoimmune reaction the body's defense system that normally protects it from infection, mistakenly begins to attack parts of the body itself. The body thinks that the tissue it is attacking is foreign material. This causes an intense inflammatory reaction to the tissue that is under attack. The shoulder actually "freezes up" due to the severe inflammation of the joint capsule. The joint capsule that usually allows a great deal of motion at the shoulder sticks together, which in turn, limits the motion. Adhesive capsulitis may begin following other injuries where the shoulder is not moved around normally because of the other injury. The condition has also been known to occur after surgical procedures for even something unrelated to the shoulder. The pain from the first condition may cause you to decrease the use of the shoulder, and the underlying condition itself may lead to chronic inflammation.
The symptoms are primarily pain and greatly reduced motion in the shoulder joint. The range of motion is the same whether you are trying to move the shoulder on your own or if someone else is trying to raise the arm for you. There comes a point in each direction of movement where the motion simply stops as if there is something blocking the movement. The shoulder usually hurts when movement reaches the limit of the range of motion, and can be quite painful at night.
The diagnosis of adhesive capsulitis is usually made on the history and physical examination. One key finding that can help differentiate adhesive capsulitis from a rotator cuff tear is how the shoulder moves. In adhesive capsulitis the shoulder motion is the same, whether the patient or the doctor tries to move the arm. In a rotator cuff tear, the patient cannot move the arm, but when someone else lifts the arm it can be moved in a nearly normal range of motion. X-rays are usually not helpful in the diagnosis; however, additional testing may also show an associated rotator cuff tear.
Treatment of the frozen shoulder may be frustrating and slow. Most cases will eventually improve, but it may be a process that may take months. It is critical that a Physical Therapy program be initiated early and continued to regain the loss of motion. Initial treatment with a physical therapist is directed at decreasing inflammation and increasing the range of motion of the shoulder with a stretching program. A home exercise program in conjunction with physical therapy is crucial to make timely progress. Anti-inflammatory medications may also be prescribed by your physician.
An injection of cortisone may bring the inflammation under better control, and allow the stretching program to be more effective. In some cases, injecting cortisone immediately before seeing a Physical Therapist can help speed up the process and decrease the overall pain level.
In extreme cases, a manipulation of the shoulder may be recommended if progress is not being made. This procedure allows your doctor to stretch the shoulder joint capsule, and break up the scar tissue while you are under anesthesia. In most cases, a manipulation of the shoulder will increase the motion in the shoulder joint faster than allowing nature to take its course.